January 4, 2018
Eric Wicklund | mHealth Intelligence
The Senate's unanimous approval follows a similar House vote last November of a bill that will give VA doctors the ability to use telehealth to treat veterans no matter where they live.
Veterans will soon be able to access healthcare no matter where they live through a telehealth connection.
Because the Senate bill is slightly different from the House bill – it bars states from denying or revoking a physician’s license for using telemedicine across state lines - the two chambers of Congress will have to agree on one bill before sending it to the White House for the President’s signature.
The legislation, sponsored by Sens. Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii) in the Senate and Reps. Julia Brownley (D-Calif.) and Glenn Thompson (R-Pa.) in the House, enables doctors employed by the U.S. Department of Veterans Affairs to use telemedicine to treat veterans no matter where they live. It also gives those practitioners an exemption from state licensure laws for this particular service.
It also mandates that VA Secretary David Shulkin report back to Congress within the year on “the effectiveness of the use of telemedicine by the Department of Veterans Affairs.”
“The VETS Act will help Hawaii veterans access high quality VA care and health services when they need it, where they need it,” Hirono said in a press release issued with Ernst. “I urge the swift enactment of the bill and will continue to fight to ensure Hawaii veterans can access the care they need from a strong, well-resourced VA system.”
Shulkin had included that telemedicine freedom in his “Anywhere to Anywhere VA Health Care” program, unveiled last fall and backed by the Justice Department. Passage of the VETS Act gives him the Congressional approval to move forward with that plan.
Some critics had said the bill would give VA doctors unprecedented authority to practice across state lines and deprive states of their ability to regulate practitioners. A similar provision in the National Defense Authorization Act for FY 2017 was stripped out of the budget before final passage in 2016 due to opposition from the American Association of Family Physicians.
“While this language would indeed ease barriers that hinder the free flow of telehealth services, it also would undermine the existing system of medical licensure, under which each state governs the practice of medicine within its borders,” AAFP Board Chairman Robert L. Wergin, MD, wrote in a 2016 letter to Congressional leaders. “Allowing physicians with a single license to treat TRICARE beneficiaries in any state via telemedicine would create episodes of medical care that the state in which the patient resides cannot readily regulate, if at all.”
The VETS Act, meanwhile, has received support from a broad range of organizations, including the AAFP, American Telemedicine Association, American Medical Informatics Association, Federal Trade Commission, Health IT Now, the College of Healthcare Information Management Executives (CHIME), Teladoc, Oracle, the American Psychological Association, the Brain Injury Association of America, the National Association of Social Workers and the University of Pittsburgh Center for Military Medicine Research.
The AAFP’s support was still guarded. The organization said it would support this specific bill to improve veterans’ access to much-needed healthcare services, though it “still strongly supports state-based licensure and regulation of physicians and other healthcare providers as well as the states’ ability to regulate the practice of telehealth in their state.”
The ATA, meanwhile, said both the VETS Act and Shulkin’s telemedicine program point out the confusing hierarchy of state and federal telemedicine licensing regulations.
“We applaud Dr. Shulkin for demonstrating the value of telehealth today at the White House.” Gary Capistrant, the ATA’s Chief Policy Officer, said in an Aug. 3, 2017 release following Shulkin’s demonstration of the program in the nation’s capital. “We encourage President Trump to issue an Executive Order to eliminate the state-by-state licensure model for all federal and private-sector health professional employees servicing federal government programs—notably agencies (such as the VA and the Department of Health and Human Services), health benefit programs (such as Medicare and TRICARE), federally-funded health sites (such as community health centers and rural clinics), and during federally-declared emergencies or disasters.”
The bill is a rare moment of victory for telemedicine and telehealth advocates looking for Congressional support for new healthcare initiatives. Several other bills – many focused on compelling the Centers for Medicare & Medicaid Services to improve access and reimbursement for telemedicine programs - have failed to make it out of committee or secure bipartisan backing.
One bill that seemed destined for passage was The Increasing Telehealth Access to Medicare Act (H.R. 3727), which would enable Medicare Advantage plans to reimburse for telehealth services at comparable rates to in-person services beginning in 2020. The bill sailed through a House committee and had been slated to be included in last year’s Medicare extenders package or with CHIP reauthorization. But that hasn’t happened, and legislative experts say the package may eventually be passed without any add-on bills.
The VETS Act is included in another bill still before Congress which aims to modernize the VA’s healthcare services.
The Veterans Community Care and Access Act of 2017, filed in December by Sens. John McCain (R-Ariz.) and Jerry Moran (R-Kansas), would establish a Veterans Community Care Program that coordinates healthcare inside and outside VA health systems for the nation’s veterans, including establishing access and quality standards, safe prescribing standards and a walk-in care protocol. It also calls on VA facilities to coordinate care with non-VA providers by sharing medical records and determining reimbursement.